Provider Demographics
NPI:1386683902
Name:THORNBURY, MELVIN DELAINE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:DELAINE
Last Name:THORNBURY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 MARTLING RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-7209
Mailing Address - Country:US
Mailing Address - Phone:256-660-5560
Mailing Address - Fax:256-660-5564
Practice Address - Street 1:431 N CARLISLE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1733
Practice Address - Country:US
Practice Address - Phone:256-840-4520
Practice Address - Fax:256-840-4527
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14828207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51550422Medicaid
AL51550422OtherBLUE CROSS BLUE SHIELD
AL51550422Medicare ID - Type Unspecified
AL51550422Medicaid